“Live uncomfortably comfortably” I said this sentence to a patient yesterday at the outpatient clinic without knowing what prompted me to say it.
“Pararat” was the first patient I talked to.
A student came to consult me for an opinion on treatment. Since he is a final-year medical student, I wanted to see the patient myself. Just a brief encounter revealed that she had more than just abnormal vaginal discharge, which is a common condition at this gynecology clinic.
“I have end-stage kidney disease. When I gave birth, I had severe preeclampsia, kidney failure, and after giving birth, the kidney failure never went away. Now I undergo dialysis here three days a week.” Patients undergoing dialysis have certain noticeable characteristics: skin, hair coarseness, and pallor.
Her home is in the northern part of the country, but having a family made her move to the southern part, in a province adjacent to my hospital.
“And how is your child now?” I asked about the child born seven years ago.
“Healthy, living with his grandparents. I see him every month.”
“What do you mean?” I was curious.
“I broke up with my boyfriend right after giving birth.”
“He had a new wife while you were pregnant?” I played the question-and-answer game.
“Yes, doctor.”
“And now you have to undergo dialysis like this, who takes care of you?” I was thinking of a woman in her late 30s who has been taking care of herself with end-stage kidney disease alone for the past seven years, traveling back and forth to see doctors and receive dialysis.
“I take care of myself, doctor. Living alone, I don’t have to be a burden to anyone.” I glanced at her treatment rights. The system indicated she was a patient under the social security system. Before she got sick, she was a manager at a foreign restaurant chain. After getting sick, she hasn’t worked since. Fortunately, the social security system she had before still benefits her now.
“May I do an internal examination? Have you had a cervical cancer screening?”
“I had it last year at Chulalongkorn Hospital.”
“Why did you go so far for the screening?”
“I registered for a kidney transplant, so they did various health checks.”
“Oh, I see. But the kidney transplant registration might take quite a while, the queue is long.” In fact, I don’t know how long it will take, but sometimes I don’t know what meaningful thing to say in matters where I admit my ignorance.
“But one thing you can trust is that the Red Cross system is transparent. The queue might not be in order, but it depends on tissue compatibility.” Think of blood groups; it’s similar, but organ transplantation is much more complex.
“And can you live like this now?”
“I can.” Her dry smile touched my heart quite a bit, not because of the disease, but the depth of life that pulled me down a bit.
“Living uncomfortably comfortably, right?” I reached out and lightly tapped her thigh. “I hope you get a kidney transplant soon.”
She raised her hands in a wai and thanked me. That dry smile had a hint of tears in her eyes for a moment.
“Don’t go praying to me, I’m not sacred.” It was a gentle way to end the conversation.
…
Aunt Dara is a little older than my mother, and that’s almost 80.
She came into the examination room in a wheelchair, with her daughter as the driver behind the wheeled chair.
On the outside, Aunt Dara looks strong, not thin, but when looking at her past medical history, her body is filled with many diseases: diabetes, hypertension, heart disease, peripheral artery disease leading to toe amputation, thyroid disease, and she came to see me because she has urinary and fecal incontinence.
My treatment involved adding some medication to reduce bladder contractions, and its side effect would increase her constipation. It should help reduce the incontinence problem somewhat, but I still referred her to a colorectal specialist for further evaluation.
“How’s life, Aunt?” Nowadays, calling a patient ‘Aunt’ makes me feel heartened. Compared to my mother’s age as a basis for counting relatives, it shows that the age gap between the patient and me is narrowing. It’s getting harder to find someone to call Aunt every day.
“It’s good, doctor. The urination issue is much better.” I glanced at her old records and found that her condition has been stable with my medication reduction for a while.
“And the fecal incontinence?”
“Now it only leaks when I go to pee.”
“You mean it doesn’t soak the diaper, right?”
“Yes, it comes out when I go to pee every time, doctor.”
“And what do you think, Aunt?”
“It’s better than before.”
“I think it’s good too. Anyway, it comes out where it should, not making a mess. So I’ll stop the medication because what you’re taking is quite a lot.” I concluded.
“And are you okay with that, Aunt?”
“Yes, doctor.” Her smile was lovely.
“Living uncomfortably comfortably, right?”
“Exactly.”
It seemed like the examination and fun conversation would end there, but Aunt Dara seemed to remember something and told her daughter to turn the wheelchair back to me.
“Don’t forget, doctor, if you pass by my house, you can stop by. It’s the house with a palm tree in front and three coconut trees.”
“Oh, Aunt, that’s easy to find. But I hate the road to your house, Phatthalung to Hat Yai, it’s always under construction, never seems to be finished.”
Pity those who travel, those who rely on travel for business or livelihood, how much opportunity is lost for the villagers.
“Living uncomfortably comfortably” seems to be just that.
Thanapan Choobun, live comfortably.
June 5, 67
Thanks to: Asst. Prof. Dr. Thanapan Choobun https://facebook.com/thanapan.choobun